How to identify high risk of vision loss in GCA?

Bhaskar Dasgupta, MD, is a professor of rheumatology at Southend University Hospital, UK, and honorary professor of Essex University, UK.

What manifestations of giant cell arteritis (GCA) are associated with a high risk of vision loss?

Thank you very much. This is a million-dollar question. If we really knew the answer to it, we would save a lot of sight loss.

You are absolutely right that the patients who go on to suffer disastrous sight loss in the face of GCA have a slightly different set of symptoms compared to the ordinary cranial GCA. For example, the patients who suffer sight loss are older than the average GCA patients, so they are quite often in the late seventies, eighties, or even in the nineties.

Many of these patients are unaware that their visual symptoms are actually related to their GCA because they do not get the classic headache, they do not get the classic scalp tenderness. They can get a problem that is often unidentified as GCA, which is jaw pain. Many of these patients get visual symptoms such as double vision, blurring of vision, or transient obscuration of vision associated with jaw pain. These patients also get constitutional symptoms, which means that they often don’t feel right and they have lost weight. They may have low-grade temperature and they have drenching night sweats.

We need to be aware of ischemic GCA in patients who are very elderly, patients who are having the typical visual symptoms of GCA in association with constitutional symptoms and particularly in association with jaw and tongue pain.